Strongyloidiasis history and symptoms: Difference between revisions

	Strongyloidiasis Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Strongyloidiasis from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms
Physical Examination
Laboratory Findings
X Ray
CT
MRI
Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Strongyloidiasis history and symptoms On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Strongyloidiasis history and symptoms All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Strongyloidiasis history and symptoms
CDC on Strongyloidiasis history and symptoms
Strongyloidiasis history and symptoms in the news
Blogs on Strongyloidiasis history and symptoms
Directions to Hospitals Treating Strongyloidiasis
Risk calculators and risk factors for Strongyloidiasis history and symptoms

VisualWikitext

Latest revision as of 00:19, 30 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Ganti M.B.B.S. [2]

Overview

Strongyloides infection can present in various forms. The majority of people infected with Strongyloides are asymptomatic. The symptomatic spectrum of strongyloidiasis ranges from subclinical in acute and chronic infection to severe and fatal in hyper infection syndrome. On acquiring the infection, there may be respiratory symptoms (Löffler's syndrome). The infection may progress to chronic stage with mainly digestive symptoms. On reinfection there may be respiratory, skin, and digestive symptoms. Finally, hyper infection syndrome sets in and cause symptoms in many organ systems, including the central nervous system.

History

The significant information that needs to be focused on in the history of the patient includes:

History of travel to the endemic areas
History of exposure to individuals with similar complaints

Symptoms

The majority of people infected with strongyloides are asymptomatic. The symptomatic spectrum of strongyloidiasis ranges from subclinical in acute and chronic infection to severe and fatal in hyperinfection syndrome and disseminated strongyloidiasis, which have case-fatality rates that approach 90%. In either case, patients’ symptoms are a result of the parasite’s larval form migrating through various organs of the body. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some patients develop abdominal pain, bloating, heartburn, intermittent episodes of diarrhea and constipation, a dry cough, and rashes.^[1]^[2]

Acute strongyloidiasis

The initial sign of acute strongyloidiasis, if noticed at all, is a localized, pruritic, erythematous rash at the site of skin penetration.
Patients may then develop tracheal irritation and a dry cough as the larvae migrate from the lungs up through the trachea.
After the larvae are swallowed into the gastrointestinal tract, patients may experience diarrhea, constipation, abdominal pain, and anorexia.

Chronic strongyloidiasis

Chronic strongyloidiasis is generally asymptomatic, but in patients with clinical disease, gastrointestinal and cutaneous manifestations are the most common.
The gastrointestinal symptoms include epigastric pain, postprandial fullness, heartburn, and brief episodes of intermittent diarrhea and constipation.
Less commonly, patients may present with fecal occult blood, or massive colonic and gastric hemorrhage.
Presentations resembling inflammatory bowel disease, specifically ulcerative colitis, are rare. Also rare, but documented, are endoscopic exams revealing pathology similar to pseudopolyposis.
Cutaneous symptoms include chronic urticaria and the pathognomonic larva currens, a recurrent serpiginous maculopapular or urticarial rash along the buttocks, perineum, and thighs due to repeated autoinfection. The rash has been described as advancing as rapidly as 10 cm/hr.
Rarely, patients with chronic strongyloidiasis have complained of arthritis, cardiac arrhythmias, and signs and symptoms consistent with chronic malabsorption, duodenal obstruction, nephrotic syndrome, and recurrent asthma.
Up to 75% of people with chronic strongyloidiasis have mild peripheral eosinophilia or elevated IgE levels.

Hyperinfection syndrome and disseminated strongyloidiasis

Hyperinfection syndrome and disseminated strongyloidiasis are most frequently associated with subclinical infection in patients receiving high-dose corticosteroids for the treatment of asthma or chronic obstructive pulmonary disease (COPD) exacerbations.
Subsequent impaired host immunity leads to accelerated autoinfection and an overwhelming number of migrating larvae.
While in chronic strongyloidiasis and hyperinfection syndrome, the larvae are limited to the GI tract and the lungs, in disseminated strongyloidiasis, the larvae invade numerous organs.
Left untreated, the mortality rates of hyperinfection syndrome and disseminated strongyloidiasis can approach 90%.

The following are signs and symptoms that can be seen with hyperinfection syndrome and disseminated strongyloidiasis:

Organ involved	Symptoms
Gastrointestinal	Abdominal pain Nausea and vomiting Diarrhea Ileus Bowel edema Intestinal obstruction Mucosal ulceration Massive hemorrhage Peritonitis Bacterial sepsis
Pulmonary	Cough Wheezing Dyspnea Hoarseness Pneumonitis Hemoptysis Respiratory failure Diffuse interstitial infiltrates
CNS	Aseptic or gram-negative meningitis Larvae have been reported in: CSF, meningeal vessels, dura, epidural, subdural, and subarachnoid spaces
Systemic	Peripheral edema and ascites secondary to hypoalbuminemia from protein losing enteropathy Recurrent gram negative bacteremia/sepsis from larvae carrying bacteria that penetrate mucosal walls Syndrome of inappropriate secretion of anti-diuretic hormone (SIADH) Peripheral eosinophilia is frequently absent
Skin	Recurrent maculopapular or urticarial rash most commonly found along the buttocks, perineum, and thighs due to repeated autoinfection, but can be found anywhere on the skin Larva currens, a pathognomonic serpiginous or urticarial rash that advances as rapidly as 10 cm/hr

References

↑ Montes M, Sawhney C, Barros N (2010). "Strongyloides stercoralis: there but not seen". Curr. Opin. Infect. Dis. 23 (5): 500–4. doi:10.1097/QCO.0b013e32833df718. PMC 2948977. PMID 20733481.
↑ Marcos LA, Terashima A, Dupont HL, Gotuzzo E (2008). "Strongyloides hyperinfection syndrome: an emerging global infectious disease". Trans. R. Soc. Trop. Med. Hyg. 102 (4): 314–8. doi:10.1016/j.trstmh.2008.01.020. PMID 18321548.

Template:WH Template:WS

[pmid20733481-1] Montes M, Sawhney C, Barros N (2010). "Strongyloides stercoralis: there but not seen". Curr. Opin. Infect. Dis. 23 (5): 500–4. doi:10.1097/QCO.0b013e32833df718. PMC 2948977. PMID 20733481.

[pmid18321548-2] Marcos LA, Terashima A, Dupont HL, Gotuzzo E (2008). "Strongyloides hyperinfection syndrome: an emerging global infectious disease". Trans. R. Soc. Trop. Med. Hyg. 102 (4): 314–8. doi:10.1016/j.trstmh.2008.01.020. PMID 18321548.

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Strongyloidiasis}}
-{{CMG}}
+{{CMG}}; {{AE}} {{ADG}}
-==History and Symptoms==
+==Overview==
+[[Strongyloides|''Strongyloides'']] infection can present in various forms. The majority of people infected with [[Strongyloides|''Strongyloides'']] are asymptomatic. The symptomatic spectrum of strongyloidiasis ranges from subclinical in acute and chronic infection to severe and fatal in hyper infection syndrome. On acquiring the infection, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may progress to chronic stage with mainly digestive symptoms. On reinfection there may be [[respiratory]], [[skin]], and [[Digestive system|digestive]] symptoms. Finally, hyper infection syndrome sets in and cause symptoms in many organ systems, including the [[central nervous system]].
-Strongyloides infection occurs in five forms. On acquiring the infection, there may be respiratory symptoms ([[Löffler's syndrome]]). The infection may then become chronic with mainly digestive symptoms. On reinfection (when larvae migrate through the body), there may be respiratory, skin and digestive symptoms. Finally, the hyperinfection syndrome causes symptoms in many organ systems, including the [[central nervous system]].<ref name=Montes>{{cite journal | author=Montes M, Sawhney C, Barros N | title=Strongyloides stercoralis: there but not seen | journal=Curr Opin Infect Dis | year=2010 | month=Oct | volume=23 | issue=5 | pages=500–4 | pmid=20733481 | pmc=2948977 | doi=10.1097/QCO.0b013e32833df718}}</ref><ref name=Marcos>{{cite journal | author=Marcos LA, Terashima A, Dupont HL, Gotuzzo E | title=Strongyloides hyperinfection syndrome: an emerging global infectious disease | journal=Trans R Soc Trop Med Hyg | year=2008 | month=Apr | volume=102 | issue=4 | pages=314–8 | pmid=18321548 | doi=10.1016/j.trstmh.2008.01.020}}</ref>
+==History==
+The significant information that needs to be focused on in the history of the patient includes:
+*History of travel to the endemic areas
+*History of exposure to individuals with similar complaints
-===Uncomplicated disease===
+==Symptoms==
-Frequently [[asymptomatic]]. [[Gastrointestinal system]] [[symptom]]s include abdominal [[pain]] and [[diarrhea]].  [[Lungs|Pulmonary]] symptoms (including [[Löffler's syndrome]]) can occur during pulmonary migration of the filariform larvae.  [[Dermatology|Dermatologic]] manifestations include [[urticaria]]l [[rash]]es in the buttocks and waist areas.  [[Blood]] [[eosinophilia]] is generally present.
+The majority of people infected with ''[[strongyloides]]'' are [[asymptomatic]]. The symptomatic spectrum of strongyloidiasis ranges from [[Subclinical infection|subclinical]] in [[acute]] and [[chronic]] infection to severe and [[fatal]] in hyperinfection syndrome and [[Strongyloidiasis|disseminated strongyloidiasis,]] which have case-fatality rates that approach 90%. In either case, patients’ symptoms are a result of the [[Parasites|parasite’s]] larval form migrating through various [[organs]] of the body. Those who do develop symptoms tend to have non-specific, or generalized complaints. Some patients develop [[abdominal pain]], [[bloating]], [[heartburn]], intermittent episodes of [[diarrhea]] and [[constipation]], a dry [[cough]], and [[rashes]].<ref name="pmid20733481">{{cite journal |vauthors=Montes M, Sawhney C, Barros N |title=Strongyloides stercoralis: there but not seen |journal=Curr. Opin. Infect. Dis. |volume=23 |issue=5 |pages=500–4 |year=2010 |pmid=20733481 |pmc=2948977 |doi=10.1097/QCO.0b013e32833df718 |url=}}</ref><ref name="pmid18321548">{{cite journal |vauthors=Marcos LA, Terashima A, Dupont HL, Gotuzzo E |title=Strongyloides hyperinfection syndrome: an emerging global infectious disease |journal=Trans. R. Soc. Trop. Med. Hyg. |volume=102 |issue=4 |pages=314–8 |year=2008 |pmid=18321548 |doi=10.1016/j.trstmh.2008.01.020 |url=}}</ref>
-Strongyloidiasis can become chronic and then become completely asymptomatic.
+===Acute strongyloidiasis===
+*The initial sign of acute [[strongyloidiasis]], if noticed at all, is a localized, [[Pruritic Urticarial Papules and Plaques of Pregnancy|pruritic]], [[erythematous]] [[rash]] at the site of skin penetration.
+*Patients may then develop [[Trachea|tracheal]] irritation and a [[dry cough]] as the larvae migrate from the [[lungs]] up through the [[trachea]].
+*After the larvae are swallowed into the [[gastrointestinal tract]], patients may experience [[diarrhea]], [[constipation]], [[abdominal pain]], and [[anorexia]].
+===Chronic strongyloidiasis===
+*[[Chronic]] [[strongyloidiasis]] is generally [[asymptomatic]], but in patients with clinical disease, [[gastrointestinal]] and [[cutaneous]] manifestations are the most common.
+*The [[gastrointestinal]] symptoms include [[epigastric]] pain, [[postprandial]] fullness, [[heartburn]], and brief episodes of intermittent [[diarrhea]] and [[constipation]].
+*Less commonly, patients may present with [[fecal occult blood]], or massive [[Colon (anatomy)|colonic]] and [[Hemorrhage|gastric hemorrhage]].
+*Presentations resembling [[inflammatory bowel disease]], specifically [[ulcerative colitis]], are rare. Also rare, but documented, are [[endoscopic]] exams revealing pathology similar to pseudopolyposis.
+*[[Cutaneous]] symptoms include [[Urticaria|chronic urticaria]] and the [[pathognomonic]] [[larva currens]], a recurrent [[serpiginous]] [[maculopapular]] or [[Rash|urticarial rash]] along the buttocks, [[perineum]], and thighs due to repeated [[autoinfection]]. The rash has been described as advancing as rapidly as 10 cm/hr.
+*Rarely, patients with [[chronic]] [[strongyloidiasis]] have complained of [[arthritis]], [[Cardiac arrhythmia|cardiac arrhythmias]], and signs and symptoms consistent with [[chronic]] [[malabsorption]], [[Obstruction|duodenal obstruction,]] [[nephrotic syndrome]], and recurrent [[asthma]].
+*Up to 75% of people with [[chronic]] [[strongyloidiasis]] have mild peripheral [[eosinophilia]] or elevated [[IgE]] levels.
-===Disseminated disease===
+===Hyperinfection syndrome and disseminated strongyloidiasis===
-Disseminated strongyloidiasis occurs when patients with chronic strongyloidiasis become [[immunosuppression|immunosuppress]]ed. It presents with abdominal pain, distension, [[Shock (circulatory)|shock]], pulmonary and neurologic [[complication (medicine)|complications]] and [[septicemia]], and is potentially fatal.  The worms enter the bloodstream from the bowel wall, simultaneously allowing entry of bowel bacteria such as ''[[Escherichia coli]]''. This may cause symptoms such as [[sepsis]] (bloodstream infection),{{citation needed | date=June 2011}} and the bacteria may spread to other organs where they may cause localized infection such as [[meningitis]].<ref name=Graeff>{{cite journal | author=Graeff-Teixeira C, da Silva AC, Yoshimura K | title=Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance | journal=Clinical Microbiology Reviews | year=2009 | month=Apr | volume=22 | issue=2 | pages=322–48 | pmid=19366917 | pmc=2668237 | doi=10.1128/CMR.00044-08 | url=http://cmr.asm.org/cgi/content/full/22/2/322}}</ref>
+*Hyperinfection syndrome and disseminated [[strongyloidiasis]] are most frequently associated with [[subclinical infection]] in patients receiving high-dose [[corticosteroids]] for the treatment of [[asthma]] or [[chronic obstructive pulmonary disease]] ([[COPD]]) exacerbations.
+*Subsequent impaired host immunity leads to accelerated [[autoinfection]] and an overwhelming number of migrating larvae.
+*While in [[chronic]] [[strongyloidiasis]] and hyperinfection syndrome, the larvae are limited to the [[GI tract]] and the [[lungs]], in disseminated [[strongyloidiasis]], the larvae invade numerous organs.
+*Left untreated, the [[Mortality rate|mortality]] rates of hyperinfection syndrome and disseminated [[strongyloidiasis]] can approach 90%.
+The following are signs and symptoms that can be seen with hyperinfection syndrome and disseminated strongyloidiasis:
-Dissemination can occur many decades after the initial infection<ref>{{cite journal | journal=Trans R Soc Trop Med Hyg | year=2004 | volume=98 | issue=6 | pages=382–6 | title=A British Second World War veteran with disseminated strongyloidiasis | author=Gill GV, Beeching NJ, Khoo S, ''et al.'' | doi=10.1016/j.trstmh.2003.11.002 |pmid=15099996 |url=http://linkinghub.elsevier.com/retrieve/pii/S0035920304000173}}</ref> and has been associated with high dose [[corticosteroids]], [[organ transplant]], [[HIV]],<ref name="Kramer1990">{{cite journal | title=Disseminated strongyloidiasis in AIDS and non-AIDS immunocompromised hosts: diagnosis by sputum and bronchoalveolar lavage | author=Kramer MR, Gregg PA, Goldstein M, Llamas R, Krieger BP. | journal=South Med J | year=1990 | volume=83 | issue=10 | pages=1226–9 | pmid=2218668 | doi=10.1097/00007611-199010000-00024
+{| class="wikitable"
-}}</ref><ref name="Gompels1991">{{cite journal | author=Gompels MM, Todd J, Peters BS, Main J, Pinching AJ. | title=Disseminated strongyloidiasis in AIDS: uncommon but important | journal=AIDS | year=1991 | volume=5 | issue=3 | pages=329–32 | pmid=2059374 | doi=10.1097/00002030-199103000-00015 }}</ref> lepromatous [[leprosy]], tertiary [[syphilis]], [[aplastic anemia]], malnutrition, advanced [[tuberculosis]] and [[radiation poisoning]].<ref>{{cite journal | journal=Am J Med | year=1974 | volume=56 | issue=4 | pages=488–93 | author=Purtilo DT, Meyers WM, Connor DH | title=Fatal strongyloidiasis in immunosuppressed patients | doi=10.1016/0002-9343(74)90481-1 |pmid=4818417 |url=http://linkinghub.elsevier.com/retrieve/pii/0002-9343(74)90481-1}}</ref>  It is often recommended that patients being started on immunosuppression be screened for chronic strongyloidiasis; however, this is often impractical (screen tests are often unavailable) and in developed countries, the prevalence of chronic strongyloidiasis is very small, so screening is usually not cost-effective, except in endemic areas.
+!Organ involved
+!Symptoms
-===Gastrointestinal===
+|-
-*[[Abdominal Pain]]
+|Gastrointestinal
-*[[Diarrhea]].
+|
+*[[Abdominal pain]]
-===Pulmonary===
+*[[Nausea]] and [[vomiting]]
-Pulmonary symptoms (including [[Loeffler’s syndrome]]) can occur during pulmonary migration of the filariform larvae.
+*[[Diarrhea]]
+*[[Ileus]]
-===Skin===
+*Bowel [[edema]]
-Dermatologic manifestations include urticarial rashes in the buttocks and waist areas.  Disseminated strongyloidiasis occurs in immunosuppressed patients, can present with [[Abdominal Pain]], [[abdominal distension]], [[shock]], pulmonary and neurologic complications and [[septicemia]], and is potentially fatal.
+*Intestinal [[obstruction]]
+*[[Mucosal]] [[ulceration]]
+*[[Massive hemorrhage]]
+*[[Peritonitis]]
+*[[Sepsis|Bacterial sepsis]]
+|-
+|Pulmonary
+|
+*[[Cough]]
+*[[Wheezing]]
+*[[Dyspnea]]
+*[[Hoarseness]]
+*[[Pneumonitis]]
+*[[Hemoptysis]]
+*[[Respiratory failure]]
+*Diffuse interstitial infiltrates
+|-
+|CNS
+|
+*[[Aseptic]] or [[Meningitis|gram-negative meningitis]]
+*Larvae have been reported in:
+**[[CSF]], [[Meninges|meningeal]] vessels, [[dura]], [[epidural]], [[Subdural empyema|subdural]], and [[Subarachnoid space|subarachnoid spaces]]
+|-
+|Systemic
+|
+*Peripheral [[edema]] and [[ascites]] secondary to [[hypoalbuminemia]] from [[protein losing enteropathy]]
+*Recurrent [[gram negative]] [[bacteremia]]/[[sepsis]] from larvae carrying bacteria that penetrate [[mucosal]] walls
+*[[Syndrome of inappropriate antidiuretic hormone|Syndrome of inappropriate secretion of anti-diuretic hormone]] ([[SIADH]])
+*Peripheral [[eosinophilia]] is frequently absent
+|-
+|Skin
+|
+*Recurrent [[maculopapular]] or [[Urticaria|urticarial rash]] most commonly found along the [[buttocks]], [[perineum]], and thighs due to repeated [[autoinfection]], but can be found anywhere on the [[skin]]
+*[[Larva currens|Larva currens]], a [[pathognomonic]] [[serpiginous]] or urticarial [[rash]] that advances as rapidly as 10 cm/hr
+|}
 ==References==
@@ Line 31: / Line 84: @@
 {{Reflist|2}}
-[[Category:Needs overview]]
+{{WH}}
+{{WS}}
 [[Category:Disease]]
+[[Category:Emergency mdicine]]
+[[Category:Up-To-Date]]
 [[Category:Infectious disease]]
+[[Category:Gastroenterology]]
-{{WH}}
+[[Category:Dermatology]]
-{{WS}}
+[[Category:Neurology]]
+[[Category:Pulmonology]]